Lead Revenue Integrity Coder Coord|
Nicklaus Children's Health System
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||Jun 20, 2018
||- n/a -
||- n/a -
||US - Florida - Miami
Manages the service lines revenue integrity to ensure coding compliance and charge capture. Educates and provides consultation services to physicians, clinical staff, and other medical staff in reference to documentation and coding including process, procedures, concerns and issues. Oversees all aspects of clinical documentation improvement (CDI) for both the facility and professional services. Leads all aspects of the Revenue Integrity Coding Coordinators.
Minimum Job Requirements
6+ years of experience with physician billing, medical coding and compliance required.
Coding or general clinical business experience in Cardiology, Operating Room experience, or Cardiovascular Lab.
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Professional Coder-Hospital (CPC-H), and/or Clinical Documentation Improvement Practitioner (CDIP) required.
Presentation experience required.
Experience in revenue cycle service lines required.
Clinical Documentation Improvement experience required.
Essential Duties and Responsibilities
Educates clinicians in reference to documentation and all aspects of coding and charge capture.
Oversees physician’s dictated and clinician notes for audit compliance and compares those notes to additional sources of clinical records.
Manages and resolves service lines documentation and coding issues and concerns in a timely manner.
Acts as a resource regarding service line documentation and coding processes.
Presents presentations in meetings relevant to audit result findings providing revenue integrity and coding compliance to physician practices and leaders.
Leads in CDM creation, reviews, and monitors CDM use to ensure compliance and communicate results to clinical department.
Educates the PFS department of missed opportunities in revenue generated areas to maximize reimbursement within standard coding guidelines.
Responsible for audits of compliance and billing issues that may affect the fiscal health of the service lines.
Leads the hospital and physician advocate when questions arise as to medical necessity with UR and others.
Creates, maintains and implements HIM and service lines coding and clinical documentation policy and procedures.
Leads and responsible for supporting and provides oversight for the organization in developing a strong clinical documentation improvement program.
Oversees and responsible for the audit process with third party vendors.
Attends and provides written reports at administrative meetings with Service Line Directors and any other meetings in regards to clinical documentation improvement.
Generates reports for data collection and analysis for tracking performance and trends.
Monitors and evaluates effectiveness of concurrent chart review and query outcomes. .
Leads with teams to identify & address opportunities for improving documentation in accordance with established standards of care, regulatory and payer requirements, internal policy & procedures.
Lead and serves as a resource person for resolution of issues related to CDI and revenue integrity.
Associate or Bachelor of Science in Health Information Management preferred.
Experience is 3M 360 encompass preferred.
ICD-10-CM experience preferred.
Strong communication skills.
Ability to communicate clearly and courteously (verbal and written) with internal and external customers.
Good organizational skills and adaptability to frequent changes in assignments.
Strong knowledge of revenue cycle including physician office or clinical hospital experience preferred.
Familiarity with cardiovascular surgical, non-invasive cardiology, and cardiac interventional procedures as well as cardiac non-invasive diagnostics a must.
Proficiency in presentation skills.
Proficiency in Microsoft Excel, Word & PowerPoint a plus.
Knowledge of managed care regulations regarding patient type criteria and appropriateness of patient type statuses by healthcare professionals when admitting patients as OP, OBS, or IPs.
Outstanding analytical and organization skills with attention to detail.
Excellent problem solving skills.
Ability to maintain confidentiality of sensitive information.
Ability to interface with compliance and outside auditors.
Strong knowledge in clinical documentation guidelines.
Excellent critical thinking skills.
Strong understanding of clinical, HIM, Quality, and case management workflow.